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Differential Diagnosis

  • Distal radius fracture
  • Ulnar styloid fracture
  • Scaphoid fracture
  • Carpal-metacarpal dislocation
  • Osteomyelitis distal radius

The x-ray reveals a fracture of the ulnar styloid, as evidenced by a break in the cortex, displacement of the fracture fragment, and a loss of alignment of the trabeculations.

Learnings/What to Look For

  • Approximately 50% of distal radial fractures will have associated ulnar styloid fracture.
  • Ulnar styloid fractures can also occur as isolated injuries, as in this case.
  • Most fractures are small avulsions at the tip, though occasionally involving the body or base of the styloid.
  • Fractures through the base of the styloid can lead to instability of the distal radioulnar joint and injury to the triangular fibrocartilage complex.
  • Accessory ossicles can appear similar to styloid avulsions.

Pearls for Initial Management and Considerations for Transfer

  • With evidence of an isolated ulnar styloid fracture, search for a distal radius fracture or a carpal fracture or dislocation.
  • If the neurovascular status is intact, the patient may be placed in an ulnar gutter or volar splint with recommendations.
  • Indications for transfer include intractable pain, consideration of vascular injury, compartment syndrome, or associated displaced fracture or dislocation.

Acknowledgment: Image courtesy of Teleradiology Specialists.

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